| NPI | 1710501242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 84209) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD20646) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2026-08-26 |